California goes from COVID-19 success story to cautionary tale

California was once a coronavirus success story, a national example of how other states could battle the virus and win.

The most populous state in the country was the first to issue a stay-at-home order, and rapidly built up a robust contact-tracing operation. While the virus was devastating hot spots on the East Coast, California managed to dodge a major catastrophe.

In the spring, as other states began lifting their stay-at-home orders, Gov. Gavin NewsomGavin NewsomNewsom warns of 'massive' budget cuts if California implements Trump unemployment plan Governors air frustrations with Trump on unemployment plans Overnight Health Care: Nearly 100,000 children tested positive for coronavirus over two weeks last month | Democrats deny outreach to Trump since talks collapsed | California public health chief quits suddenly MORE (D) repeatedly stressed a cautious, science-based approach to reopening.

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But now California is in trouble. As the state joins Arizona, Texas and Florida as one of the worst coronavirus hot spots in the country, state leaders and public health experts say it should be viewed as a cautionary tale.

"We flattened the curve in California. What we didn't do was turn it downward," state Sen. Richard Pan (D) said in an interview. "Then started opening things up again, and then of course now we have an upward swing again."

Daily coronavirus cases have spiked, with an average of 6,000 new infections a day in the past week. The percentage of positive tests is the highest in months, with the biggest increase in just the last two weeks. 

Hospitalizations have jumped 51 percent in the past two weeks, and ICU admissions are up 47 percent over the same period.

After being proactive in issuing a statewide stay-at-home order, Newsom let the 58 individual counties make their own reopening decisions, beginning in early May.

His plan initially allowed for limited retail stores to open with capacity and physical distancing requirements, but in a matter of weeks quickly allowed counties to open dine-in restaurants, gyms, nail salons and religious services.

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In many instances, experts said, that flexibility likely allowed local governments to rush ahead and reopen before they were ready.

Pan, a practicing pediatrician, said when the messaging shifted from the importance of staying at home to safely reopening businesses, people took it as a green light to reopen no matter what the local conditions were like.

"And now we're recognizing, unfortunately, the consequences of that," Pan said. "You don't need huge numbers of people to get complacent. All it takes is a small percentage of people, whether it's politics or for other reasons, and they're not following the guidelines, then the disease is going to spread."

Local epidemiologists said reopening likely contributed to some of the case spikes, but there are other reasons as well. California has the world's fifth-largest economy, and the sheer size of the state means each county comes with its own unique challenges in handling the virus.

George Rutherford, a professor of epidemiology at UC San Francisco, said the problems with California's large, diverse population are a window into what's happening throughout the country: virus outbreaks in San Quentin prison, Latino essential workers living in shared housing units in Imperial County and young people in Los Angeles flooding the bars and beaches on Memorial Day weekend.

Rutherford said because of that size and diversity, Newsom had to let counties make their own decisions.

"What goes on in the far northern-tier counties in California, and what goes on on the Mexican border are completely different," Rutherford said. "So you really have to ... approach this, at least, regionally. There's a lot of territory to cover."

Still, Rutherford said the surge has taken people by surprise.

"We knew that there would be cases when we reopened. We knew that there'd be a trade-off between the economy and disease. I don't think anybody realized it would be this pronounced during June," he said.

Art Reingold, head of the Epidemiology and Biostatistics division at the UC Berkeley School of Public Health, said the tailored approach to reopening was the best option, but also the most complicated.

"I think that the governor didn't have terribly good options in terms of trying to mandate statewide goals and enforcing them equally across very different counties and situations," Reingold said. "You know, I don't know that any governor could have successfully done that.”

Newsom has begun cracking down and re-imposing restrictions, but there's concern he may be too late.

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On June 18, Newsom imposed a statewide mask requirement. On July 1, he took the strictest steps yet and ordered all indoor nonessential businesses to close in 19 counties across the state — a move that affects more than 75 percent of the state's population.

As a way to control crowds during the July 4 weekend, Newsom will close all the parking lots at state-run beaches throughout Southern California and the Bay Area.

“I deeply respect people’s liberty, their desire to go back to the way things were, but I cannot impress upon you more, our actions have an impact on other people," Newsom said.

The restrictions will remain in place for at least three weeks.

Reingold said the restrictions can help, but the ultimate impact is limited because the virus is so widespread.

"The value of these measures are much more likely to be successful when there are relatively few infections, and much less likely to be successful when there are a lot more infections," Reingold said.

"And so unfortunately we're now at a stage where we've got an awful lot of people infected with this virus in the United States and California. So I'm not sure how much we can expect in the way of a successful intervention at this point," he added.